%0 Journal Article
%T Motor component of the glasgow coma scale performs similar to calculated total glasgow coma scale in predicting severe injury in trauma patients
%J Annals of emergency medicine
%D 2016
%A Kupas, Douglas F.
%A Melnychuk, Eric M.
%A Young, Amanda J.
%V 68
%N 6
%P 744-750.e3
%X STUDY OBJECTIVE: Trauma victims are frequently triaged to a trauma center according to the patient's calculated Glasgow Coma Scale (GCS) score despite its known inconsistencies. The substitution of a simpler binary assessment of GCS-motor (GCS-m) score less than 6 (ie, "patient does not follow commands") would simplify field triage. We compare total GCS score to this binary assessment for predicting trauma outcomes. <br><br>METHODS: This retrospective analysis of a statewide trauma registry includes records from 393,877 patients from 1999 to 2013. Patients with initial GCS score less than or equal to 13 were compared with those with GCS-m score less than 6 for outcomes of Injury Severity Score (ISS) greater than 15, ISS greater than 24, death, ICU admission, need for surgery, or need for craniotomy. We judged a priori that differences less than 5% lack clinical importance. <br><br>RESULTS: The relative differences between GCS and GCS-m scores less than 6 were less than 5% and thus clinically unimportant for all outcomes tested, even when statistically significant. For the 6 outcomes, the differences in areas under receiver operating characteristic curves ranged from 0.014 to 0.048. Total GCS score less than or equal to 13 was slightly more sensitive (difference 3.3%; 95% confidence interval 3.2% to 3.4%) and slightly less specific (difference -1.5%; 95% confidence interval -1.6% to -1.5%) than GCS-m score less than 6 for predicting ISS greater than 15, with similar overall accuracy (74.1% versus 74.2%). <br><br>CONCLUSION: Replacement of the total GCS score with a simple binary decision point of GCS-m score less than 6, or a patient who "does not follow commands," predicts serious injury, as well as the total GCS score, and would simplify out-of-hospital trauma triage.<br><br>Copyright © 2016 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.<p /> <p>Language: en</p>
%G en
%I Elsevier Publishing
%@ 0196-0644
%U http://dx.doi.org/10.1016/j.annemergmed.2016.06.017